Geography Reference
In-Depth Information
of life-style choices, regulations on access to addictive substances make it easier or
harder to obtain these unhealthy substances.
The impact of each factor varies according to the various circumstances in and
between urban places. Indeed all these factors combine in various proportions to
make significant place differences in the health of income groups and areas, es-
pecially in an urban context, between and within diverse towns and cities. The
intra-urban differences often lead to an ecology of health disadvantage within
cities, creating what has been called an
urban health penalty
(Greenberg
1991
).
These unhealthy areas are characterised by limited health care facilities, people
with poor life-style choices, substandard residences and often polluted conditions,
low incomes, few economic prospects and a stressful, unsafe and socially isolated
life. These conditions are made worse by feelings of hopelessness and the negative
biological embedding of the harsh social environment. Increasing concern about
the persistence of these pockets of ill-health has been one of the reasons why a new
approach to the health care structure of many cities was developed.
136
The New Healthy City Movement and Organizations
Towards the end of the twentieth century, the challenges associated with improving
the health of the population led many to the realization it was not appropriate to
depend
only
on treating our way out of ill-health through the work of the medical
profession alone. New forms of organizations and initiatives were also needed as
well as a wider ecological view. It led the World Health Authority (WHO) to create
the Healthy Cities programme in 1986 (Kenzer
1999
). To some extent this was a
broader version of The Ottawa Charter of 1986 that had established criteria for mak-
ing Canadian cities healthier. Although initially restricted to the developed world,
the Healthy Cities programme spread to cities in all parts of the world from 1994
and by the end of 2013 comprises a network of over a thousand cities worldwide,
with both continental organizations as well as national ones, such as the 29 cities
that comprise the U.K. network. The most successful Healthy Cities programmes
maintain momentum from five values: a clear vision to promote health; the com-
mitment of local community members; the ownership of policies; a wide array of
stakeholders; and a process for institutionalizing the programme (WHO
1998
). It is
left to adopters to organize their own structures on the basis that governance varies
widely between countries and locals know their own needs and priorities. The risk
of this autonomy is that some cities lack the resources to develop good guidance
and policies. To counteract this, membership of this network allows cities to learn
from one another and to use 'best practice' ideas pioneered by other centres. The
influence of this programme has also led many non-members to review their own
approaches to improving health care, in which six major new trends are prominent,
namely: creating health impact assessments; new political engagements; raising
public awareness; adding community engagement; improving private participation;
and finally, a more specific spatial targeting to improve conditions in persistent
areas of ill-health.
